In this inaugural Community Outbreak Preparedness Index, Heluna Health identifies both encouraging and unsettling trends in preparedness among California’s 58 counties. No other state combines such extraordinary geographic, economic and cultural contrasts. California is home both to Los Angeles County, the most populous county in the United States, along the Pacific coast, and counties situated in vast high deserts with some of the lowest population densities in the country. Collectively, these differences present unparalleled challenges to public health, well-being and emergency preparedness.
Among the trends the data reveal:
- In hospital medical surge capacity, the state’s larger counties perform well on four key indicators that impact preparedness: hospital staff, supplies, space, and systems. Among the best-scoring counties are San Diego, Contra Costa, Monterey, San Mateo and Sacramento, as well as some smaller communities that share capacity in joint healthcare coalitions.
- The widespread lack of safe, affordable housing has profound implications for outbreak preparedness. Too many Californians struggle to pay for basic housing and face poor conditions, increasing the risks of disease transmission and compounding burdens on the healthcare system. In locations where a high percentage of residents face one of several core housing problems — including overcrowding and high costs — Los Angeles County tops the list, with over 32% facing more than one core housing challenge, followed by Monterey (29%) and Santa Barbara (29%).
- Social capital measures — which assess the strength of community networks — are higher in less populous counties, nearly across the board. Community networks, measured here by factors like the prevalence of civic organizations and high voter turnout, help support communication, planning and responses during outbreak events. The five counties with the highest social capital measures — Alpine, Plumas, Sierra, Siskiyou, and Mariposa — each have fewer than 50,000 residents, and perform well in factors like membership organizations, nonprofits, and presidential voting.
- The most populous counties have above-average preventable hospitalizations. While California has a state average of 3,358 preventable hospital stays per 100,000, Los Angeles has 4,053; Riverside has 3,564; San Bernardino has 4,170; Fresno has 3,839; and Sacramento has 3,603.
- Smaller, typically rural counties struggle with food insecurity and pediatric vaccination — particularly immunizations required for children to attend schools. Imperial, Del Norte, Sierra, Siskiyou and Alpine are the five counties in California with the least reliable access to sources of healthy food, based on our analysis. El Dorado, Nevada, Sutter, Tuolumne and Glenn are among the 12 counties reaching fewer than 90% of school-aged children with pediatric vaccination.
- Many eligible Californians in more populous counties are not fully enrolling in the CalFresh program to receive SNAP food benefits. This gap between eligibility and participation includes vulnerable populations in San Mateo, Placer, San Luis Obispo, Santa Clara, Sonoma, Orange, Contra Costa, and Riverside counties. Research has shown that food insecurity can increase vulnerability to infection and a host of other adverse health outcomes.
- Almost every California county could do more to adequately staff nursing homes, reducing communicable disease risks to vulnerable populations of older Californians. In 52 of 55 counties where data is available, at least a third of nursing homes fall short of the recommended nursing staff ratios. And in 30 counties — including Los Angeles, San Diego, Orange, Riverside and San Bernardino — more than half of nursing homes are short-staffed.